Counseling African Americans to Control Hypertension: cluster-randomized clinical trial main effects

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Limited data exist on implementing evidence-based, multilevel interventions for blood pressure (BP) control in hypertensive Black individuals within low-resource primary care settings.
• Hypertension remains a significant health concern, particularly in minority populations, necessitating effective management strategies.

Purpose of the Study:

• To evaluate the effectiveness of a practice-based, multicomponent intervention aimed at improving blood pressure (BP) control in hypertensive Black adults receiving care in community health centers.
• To assess the impact of patient education, home BP monitoring, and lifestyle counseling, alongside physician support, on BP control rates.

Main Methods:

• A cluster-randomized clinical trial involving 30 community health centers, randomly assigned to either an intervention condition (IC) or usual care (UC).
• The intervention included patient education, home BP monitoring, monthly lifestyle counseling, and physician support through hypertension case rounds and feedback.
• The primary outcome was BP control at 12 months, with secondary outcomes including changes in systolic and diastolic BP, assessed using an automated BP device in 1059 patients.

Main Results:

• The overall BP control rate was similar between the intervention (49.3%) and usual care (44.5%) groups (odds ratio, 1.21; P=0.21).
• Subgroup analyses revealed greater BP control in the intervention group for patients without diabetes mellitus (54.0% vs. 44.7%) and in small-sized community health centers (51.1% vs. 39.6%).

Conclusions:

• A practice-based, multicomponent intervention was not superior to usual care in improving BP control among hypertensive Black adults.
• Future research should focus on developing more efficient and tailored behavioral modification strategies for hypertension control in high-risk populations within low-resource settings.